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目的:评价β受体阻滞剂美托洛尔单独或与血管紧张素转换酶(ACE)抑制剂贝那普利联合应用对隐匿性肾功能不全的轻、中度高血压患者肾小球滤过功能的影响。方法:73例隐匿性肾功能不全的高血压患者,随机分为美托洛尔(MET)、美托洛尔+贝那普利(MET+BEN)两组,分别应用美托洛尔50～75mg/d或美托洛尔25mg/d+贝那普利5～10mg/d,疗程6个月。血压控制目标为140/90mmHg。治疗前和治疗满6个月时,检测两组患者血尿酸(SUA)血肌酐(Scr)和肾小球滤过率GFR。结果:①治疗后,MET组与MET+BEN组的血压平均水平的差别均无统计学意义(131.3±9.9/71.9±10.5,132.0±10.2/68.9±10.7mmHg,P均>0.05),血压控制达标率亦无显著差别(78.4%,77.8%,P>0.05)。②治疗后MET组血尿酸、肌酐较治疗前升高(439±62,429±57mmol/L,P<0.05;109±17,103±14μmol/L,P<0.01),肾小球滤过率轻度下降(49.9±6.9,52.9±5.8mL/min·1.73m2,P<0.01);③MET+BEN组血尿酸、血肌酐较治疗前降低(417±57,426±62mmol/L,P<0.01;98±12,105±13μmol/L,P<0.01),肾小球滤过率较治疗前升高(54.7±6.2,51.3±5.6mL/min·1.73m2,P<0.01)。④治疗6个月后,MET+BEN组血尿酸、血肌酐均低于MET组(417±57,439±62mmol/L,P<0.01;98±12,109±17μmol/L,P<0.01),肾小球滤过率高于MET组(54.7±6.2,49.9±6.9ml/min·1.73m2,P<0.01)。结论:对合并隐匿性肾功能不全的高血压患者,应避免单独应用美托洛尔,以免加重肾小球滤过功能的损害;而美托洛尔与贝那普利联合应用,可能有益于肾功能的保护。
PURPOSE: To evaluate the effects of metoprolol, a beta blocker, alone or in combination with benazepril, an inhibitor of angiotensin converting enzyme (ACE) inhibitor, on glomerular filtration in patients with mild and moderate hypertension with occult renal insufficiency The effect of over function. Methods: Seventy three hypertensive patients with occult renal insufficiency were randomly divided into metoprolol (MET), metoprolol and benazepril (MET + BEN) 75mg / d or metoprolol 25mg / d + benazepril 5 ~ 10mg / d, course of treatment for 6 months. Blood pressure control target is 140 / 90mmHg. Serum creatinine (SUA) and glomerular filtration rate (GFR) were measured before treatment and 6 months after treatment. Results: ① After treatment, there was no significant difference in average blood pressure between MET group and MET + BEN group (131.3 ± 9.9 / 71.9 ± 10.5,132.0 ± 10.2 / 68.9 ± 10.7mmHg, P> 0.05) There was no significant difference between the compliance rates (78.4%, 77.8%, P> 0.05). ② After treatment, serum uric acid and creatinine in MET group were significantly higher than those before treatment (439 ± 62,429 ± 57 mmol / L, P <0.05; 109 ± 17,103 ± 14μmol / L, P <0.01) 49.9 ± 6.9,52.9 ± 5.8mL / min · 1.73m2, P <0.01). ③The serum uric acid and serum creatinine were lower in patients with MET + BEN than those before treatment (417 ± 57,426 ± 62mmol / L, P <0.01; 98 ± 12,105 ± 13μmol /L, P <0.01), glomerular filtration rate was higher than before treatment (54.7 ± 6.2,51.3 ± 5.6mL / min · 1.73m2, P <0.01). ④ After 6 months treatment, serum uric acid and serum creatinine in MET + BEN group were lower than those in MET group (417 ± 57,439 ± 62mmol / L, P <0.01; 98 ± 12,109 ± 17μmol / L, P <0.01) The filtration rate was higher than that of MET group (54.7 ± 6.2,49.9 ± 6.9ml / min · 1.73m2, P <0.01). CONCLUSIONS: Metoprolol should be avoided in hypertensive patients with occult renal insufficiency, so as not to aggravate the impairment of glomerular filtration function; while the combination of metoprolol and benazepril may be beneficial Protection of renal function.